How do we manage blood product support in the massively hemorrhaging obstetric patient?

Abstract

Obstetric hemorrhage remains a leading cause of maternal mortality with more than 140,000 deaths annually worldwide. Abnormal placentation has increased to become the most common diagnosis requiring massive blood transfusion in obstetrics, with uterine atony a close second. At our institution, as well as nationwide, there has been a steady increase in pregnancies complicated by abnormal placentation, including accreta, increta, and percreta. Providers at our facility created the New England Center for Placental Disorders in May 2015 to address these complex patients. The incidence of accreta has actually increased 10-fold over the past 50 years, becoming the most common reason for cesarean hysterectomy in highly industrialized countries. The most common risk factor for accreta is repeat cesarean sections, particularly those with associated placenta previa. Contemporary cesarean section rates have risen, with more than 1.2 million women having had a cesarean section in the United States in 2014. We present a case vignette of a multiparous woman presenting with heavy vaginal bleeding at 30 weeks' gestation with imaging concerning for placenta accreta and possible percreta. We describe our approach to the management of these complicated patients.

Differential effects of different delivery methods on progression to severe postpartum hemorrhage between Chinese nulliparous and multiparous women: a retrospective cohort study

“…Previous studies reported that the multiparous pregnancy had a higher risk for PPH than nulliparous pregnancy [ 6 , 8 , 13 , 15 , 16 , 19 , 39 ], when parity was included as one of the independent variables. This study shows that multiparous women have a greater risk for progression to severe PPH than nulliparous women if they received CS or forceps-assisted delivery.…”

“…Most PPH-related studies about the difference between nulliparous and multiparous women are generally consistent in that compared with nulliparous, being multiparous would be a protective factor of PPH [ 6 , 8 , 13 , 15 – 19 ]. The reason behide this is perhaps that previous studies just analyzed their samples without considering the differential effects of delivery methods on the specific parturients that might be modified by parity, i.e.…”

The management of emergency blood transfusion including massive transfusion, emergency and massive transfusion

“…Brzo obezbeĎivanje krvi i krvnih komponenti u ovim situacijama mogu biti od vitalnog značaja [3]. Najčešća urgentna stanja u kojima je potrebna efikasna transfuzija su: masivna akušerska krvarenja, pedijatrijske traume, neonatalna krvarenja, masivna gastrointestinalna krvarenja, urgentna stanja u hematologiji, trauma i dr. [4][5][6][7].…”

Blood Saving Possibilities in Delivering Patients with Placenta Increta

“…Многочисленные исследования показывают прямую зависимость между возрастающим количеством кесаревых сечений и случаев аномального прикрепления плаценты [3][4][5][6]. В настоящее время кесарево сечение является самой частой операцией в мире.…”